Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis
BackgroundThe available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance.MethodsOur MSU in upstate New York serv...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.868051/full |
| _version_ | 1818200228570857472 |
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| author | Nathaniel R. Ellens Derrek Schartz Redi Rahmani Sajal Medha K. Akkipeddi Adam G. Kelly Curtis G. Benesch Stephanie A. Parker Jason L. Burgett Diana Proper Webster H. Pilcher Thomas K. Mattingly James C. Grotta Tarun Bhalla Matthew T. Bender |
| author_facet | Nathaniel R. Ellens Derrek Schartz Redi Rahmani Sajal Medha K. Akkipeddi Adam G. Kelly Curtis G. Benesch Stephanie A. Parker Jason L. Burgett Diana Proper Webster H. Pilcher Thomas K. Mattingly James C. Grotta Tarun Bhalla Matthew T. Bender |
| author_sort | Nathaniel R. Ellens |
| collection | DOAJ |
| description | BackgroundThe available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance.MethodsOur MSU in upstate New York serves 741,000 people. We present prospectively collected, retrospectively analyzed data from the inception of our MSU in October of 2018, through March of 2021. Rates of transportation/dispatch and MSU utilization were reported. We also performed a meta-analysis using MEDLINE, SCOPUS, and Cochrane Library databases, calculating rates of tPA/dispatch, tPA-per-24-operational-hours (“per day”), mechanical thrombectomy (MT)/dispatch and MT/day.ResultsOur MSU was dispatched 1,719 times in 606 days (8.5 dispatches/24-operational-hours) and transported 324 patients (18.8%) to the hospital. Intravenous tPA was administered in 64 patients (3.7% of dispatches) and the rate of tPA/day was 0.317 (95% CI 0.150–0.567). MT was performed in 24 patients (1.4% of dispatches) for a MT/day rate of 0.119 (95% CI 0.074–0.163). The MSU was in use for 38,742 minutes out of 290,760 total available minutes (13.3% utilization rate). Our meta-analysis included 14 articles. Eight studies were included in the analysis of tPA/dispatch (342/5,862) for a rate of 7.2% (95% CI 4.8–9.5%, I2 = 92%) and 11 were included in the analysis of tPA/day (1,858/4,961) for a rate of 0.358 (95% CI 0.215–0.502, I2 = 99%). Seven studies were included for MT/dispatch (102/5,335) for a rate of 2.0% (95% CI 1.2–2.8%, I2 = 67%) and MT/day (103/1,249) for a rate of 0.092 (95% CI 0.046–0.138, I2 = 91%).ConclusionsIn this single institution retrospective study and meta-analysis, we outline the following operational metrics: tPA/dispatch, tPA/day, MT/dispatch, MT/day, and utilization rate. These metrics are useful for internal and external comparison for institutions with or considering developing mobile stroke programs. |
| first_indexed | 2024-12-12T02:34:20Z |
| format | Article |
| id | doaj.art-d37c5a19ab124ee5842fe02f61284fff |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-12-12T02:34:20Z |
| publishDate | 2022-05-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-d37c5a19ab124ee5842fe02f61284fff2022-12-22T00:41:19ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-05-011310.3389/fneur.2022.868051868051Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-AnalysisNathaniel R. Ellens0Derrek Schartz1Redi Rahmani2Sajal Medha K. Akkipeddi3Adam G. Kelly4Curtis G. Benesch5Stephanie A. Parker6Jason L. Burgett7Diana Proper8Webster H. Pilcher9Thomas K. Mattingly10James C. Grotta11Tarun Bhalla12Matthew T. Bender13Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurology, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurology, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurology, University of Texas McGovern Medical School, Houston, TX, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesMobile Stroke Unit, Memorial Hermann Hospital—Texas Medical Center, Houston, TX, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesBackgroundThe available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance.MethodsOur MSU in upstate New York serves 741,000 people. We present prospectively collected, retrospectively analyzed data from the inception of our MSU in October of 2018, through March of 2021. Rates of transportation/dispatch and MSU utilization were reported. We also performed a meta-analysis using MEDLINE, SCOPUS, and Cochrane Library databases, calculating rates of tPA/dispatch, tPA-per-24-operational-hours (“per day”), mechanical thrombectomy (MT)/dispatch and MT/day.ResultsOur MSU was dispatched 1,719 times in 606 days (8.5 dispatches/24-operational-hours) and transported 324 patients (18.8%) to the hospital. Intravenous tPA was administered in 64 patients (3.7% of dispatches) and the rate of tPA/day was 0.317 (95% CI 0.150–0.567). MT was performed in 24 patients (1.4% of dispatches) for a MT/day rate of 0.119 (95% CI 0.074–0.163). The MSU was in use for 38,742 minutes out of 290,760 total available minutes (13.3% utilization rate). Our meta-analysis included 14 articles. Eight studies were included in the analysis of tPA/dispatch (342/5,862) for a rate of 7.2% (95% CI 4.8–9.5%, I2 = 92%) and 11 were included in the analysis of tPA/day (1,858/4,961) for a rate of 0.358 (95% CI 0.215–0.502, I2 = 99%). Seven studies were included for MT/dispatch (102/5,335) for a rate of 2.0% (95% CI 1.2–2.8%, I2 = 67%) and MT/day (103/1,249) for a rate of 0.092 (95% CI 0.046–0.138, I2 = 91%).ConclusionsIn this single institution retrospective study and meta-analysis, we outline the following operational metrics: tPA/dispatch, tPA/day, MT/dispatch, MT/day, and utilization rate. These metrics are useful for internal and external comparison for institutions with or considering developing mobile stroke programs.https://www.frontiersin.org/articles/10.3389/fneur.2022.868051/fullmobile stroke unit (MSU)ambulancemechanical thrombectomy (MT)tissue plasminogen activator (tPA)operational performance |
| spellingShingle | Nathaniel R. Ellens Derrek Schartz Redi Rahmani Sajal Medha K. Akkipeddi Adam G. Kelly Curtis G. Benesch Stephanie A. Parker Jason L. Burgett Diana Proper Webster H. Pilcher Thomas K. Mattingly James C. Grotta Tarun Bhalla Matthew T. Bender Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis Frontiers in Neurology mobile stroke unit (MSU) ambulance mechanical thrombectomy (MT) tissue plasminogen activator (tPA) operational performance |
| title | Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis |
| title_full | Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis |
| title_fullStr | Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis |
| title_full_unstemmed | Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis |
| title_short | Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis |
| title_sort | mobile stroke unit operational metrics institutional experience systematic review and meta analysis |
| topic | mobile stroke unit (MSU) ambulance mechanical thrombectomy (MT) tissue plasminogen activator (tPA) operational performance |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.868051/full |
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